Current/Former Employers

Most Recent Employer

Previous Employer

From

To

Employer Name

Employer Phone

Position

Salary

Reasons for Leaving

Qualifications

Documentation of authorization to work in the U.S. is required. Are you legally authorized to work in the United States?

Have you ever been convicted of a crime other than a misdemeanor?
A conviction will not automatically bar you from employment. Each conviction will be evaluated on its own merits with respect to the offense, the date of the conviction, and the sentence imposed. All circumstances will be considered.

If yes, please describe further:

Are you able to perform the essential functions of the job you are applying for with or without accommodation?

Emergency Contact

Name

Address

Phone

Agreement

All the information provided by me is true and complete. I understand that any false information, misrepresentation, or material omission may result in discipline or discharge. I authorize investigation of all statements in this application and regarding my previous employment and disclosure of any information, personal or otherwise, related to my background and I release all parties from liability for furnishing or requesting such information.

Under Michigan law, but not federal law, I understand that have 182 days from the date I know or reasonably should know that an accommodation is needed to request, in writing, an accommodation. Failure to do so may result in a loss of rights under Michigan law.

I understand that if hired my employment is on an at-will basis, which means that it may be terminated by either me or the Company for any reason or no reason, with or without cause, at any time, with or without advance notice or warning. Only an agreement in writing expressly for the purpose of modifying the at-will nature of employment and signed by the Company's CEO can modify the at-will nature of employment. I agree to abide by the Company's rules, regulations, policies, and procedures. I further understand and that I may be required to submit to tests for drugs and/or alcohol at the Company's discretion. I understand that the Company's rules and regulations may change with or without advanced notice to me.

In consideration of my employment, I agree not to commence any action or suit against NCI, its employees or agents relating to my employment or the termination of my employment with the Company more than 180 days after the event giving rise to the claim(s) or be forever barred. I understand that I am waiving any statute of limitation longer, but not shorter, then this period. However, I understand that this provision does not limit my ability to pursue a federal agency charge or a claim resulting from such charge beyond that time period as permitted by law.

Do you accept the terms and conditions above that will govern your employment with NCI?